| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,322 |
2,317 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,366 |
707 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,855 |
2,837 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
2,620 |
2,549 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,197 |
2,190 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,481 |
717 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
827 |
553 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
6,088 |
5,906 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,584 |
2,574 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,023 |
1,017 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,079 |
4,313 |
$45K |
| D1120 |
Prophylaxis - child |
639 |
634 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
714 |
712 |
$17K |
| D4355 |
|
268 |
265 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
28 |
$3K |
| D2332 |
|
22 |
12 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
14 |
$747.50 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$284.35 |